Why I Am No Longer Chief Medical Officer
My original journey into medicine was not dissimilar from that of millions of my colleagues: I viewed medicine as a means to help people achieve a better human existence. When bodies fall into disrepair, physicians are there to right the ship, to re-set the course. Through glamorized blockbuster drugs and risky but rewarding surgery we obliterate tumors, replace hearts, and correct metabolic imbalances. We can now even cure genetic conditions such as sickle cell anemia through gene editing. These spectacular successes fuel an abundance of fictional and non-fictional televised stories of heroic saviors of patients snatched from death’s grasp. Such is the sexy appeal of modern medicine.
As a maternal-fetal medicine physician I too revel in this existence. I sweep in at the final hour to make lifesaving decisions for patients and their families — decisions that amount to no less than ensuring the continuity of humanity through one mother and baby at a time. The self-reinforcing ego boost is so compelling, so invigorating, and so addictive that it often is sufficient to fuel a 3 to 4-decade long career despite numerous long nights, extraordinarily difficult conversations, and not insignificant medico-legal risks.
However, many physicians are not purely acute interventionists like trauma surgeons or interventional cardiologists. Maternal-fetal medicine involves a great deal more than rescue cervical cerclages and emergency c-sections; to the contrary, much rests on mitigating risk through preventive measures such as screening fetal ultrasounds, genetic testing, risk factor assessments for preeclampsia, gestational diabetes, preterm birth and other complications, guided monitoring and judicious use of medications, as well as potentially advising patients to terminate or avoid pregnancy altogether. None of these are acutely heroic, but rather measured interventions.
Evident to me, mid-career and with the perspective of looking beyond short-lived ego boosts, is that many smaller events lead up to these momentous final decisions. These smaller events are consequential, but more importantly, modifiable and influenceable — and all too often fall outside the purview of “traditional” medicine that is ensconced within the four walls of a clinic or a hospital. What happens before conception, not just from nutrition, cardiovascular health, and pelvic floor strength, but also from a lifetime of environmental exposures, income, societal prejudices and so much more, directly impacts much of what occurs in pregnancy, childbirth, and the years beyond. Twenty-three years into being a licensed physician, with an estimated 40,000+ individual patient encounters under my belt, looking upon a vast history of these smaller individual events as well as larger societal conditions, I can definitively state that we are deeply unhealthy as individuals, and collectively as societies. Even worse, doctors have diminishing capability to bend the narrative arc.
This is because medicine is about intervention when there is sickness and injury. Medical doctors are trained to think as such: to restore equilibrium where there is newfound disequilibrium. We stand ready in emergency rooms, in clinical offices, in radiology centers, and in surgical theaters to do just this. But health stands in contradistinction to medicine. Health is about maximizing the human condition by maintaining and strengthening equilibrium. It is about more than simply vital signs and blood tests — it is about social context and environment, about relationships and freedom, about access and empowerment, about education and prevention. Health diminishes the need for medicine. Certainly at times one needs medicine to restore health, but many times one needs much more than that, for health exists along a continuum and is a process of resilience-building, not a fixed state of being. This perspective makes every moment an opportunity for change and improvement.
Medicine in the United States, and ever increasingly in the world at large, finds itself in a conundrum. Medicine is and will always be there. There will always be a major role for standing upright those who have fallen. But individuals and the societies they comprise are ailing rapidly, falling into disrepair. As people fall ever more frequently into disequilibrium, societies call upon medicine to play a greater and greater role, but this comes at tremendous cost. Fixing disrepair is always more expensive than maintaining a state of repair.
The health startup community, and the investors backing founders, has largely doubled down on medicine over health. This makes sense. There is a lot of innovation to be had, and a lot of money to be made. Individuals and their societies will pay large sums of money to fix ailing and injured bodies. But more and more of us are falling ill, and due to neglect of health in its most holistic form, disadvantaged groups of people fall into illness disproportionately more than others. Health startups often ignore solutions for these groups as compensation tends to be significantly less, if even existent at all, in caring for them.
Adding insult to injury, there are not enough doctors, nurses, and allied health professionals to deal with rising rates of calamity. There is not enough money to go around. And simply spending large sums to stand upright the fallen, without addressing the root causes of why they fell in the first place, does not lead to real prosperity or innovation, but rather to insidious societal decline. In a better world many of these dollars would be spent elsewhere. In our efforts for convenience we build and grow carelessly. We neglect our well-being for instant gratification. And we build financial rewards for doing the easy work, but not the hard work. This gross misalignment between financial success and human success will go on to cause immense damage if left uncorrected. I have seen this occur in women’s health — especially pregnancy health.
Apart from birth and death, pregnancy itself is one of the most inexplicable — and nothing short of spiritual — events in a human being’s life. Those of us who lack a uterus stand on the sidelines, witnesses to this remarkable phenomenon, just as when I was to my wife’s three pregnancies. In medical school, after a brief foray with rehab medicine, I wanted to become an interventional cardiologist. I envisioned forcing open clotted arteries and restoring blood flow to ischemic myocardium; in so doing I would tell families I saved their loved ones from the clutches of death. I would be a hero in a white cape. But nothing prepared me for my obstetrics rotation when my hands directly held emerging life from the womb. I was irrevocably changed. I abandoned cardiology in favor of working to support patients who found themselves taking on the burden of continuing the life of our species.
Pregnancy is all about dynamic equilibrium and resilience. Fusion of egg and sperm unleashes a nearly indefatigable life force that compels a mother’s body to nourish a primordial ball of pluripotent cells. Every organ system, mind included, in maternal biology adapts, and must continue to adapt, as the next generation grows, develops, and eventually is birthed. At no point is there rest, at no point is there stasis. And just as shortly after a rocket launches, there is no more a dangerous time for those on the ground or for those aloft than after birth. It is an incredible demand that leaves no one unaltered — mother, child, and family. In the context of excellent health it is akin to a gyroscope — steady, upright, and difficult to throw off balance. But in the context of poor health a myriad array of adverse forces destabilize and compromise the entire process.
Over nearly three decades since medical school I have seen rising rates of obesity, diabetes, hypertension, and mental affliction. But I have also seen rising rates of environmental harms, from microplastics and chemical pollutants to rising heat to more extreme climatic events to worsening air pollution, and to increasing socioeconomic disparities leading to greater and greater challenges for patients to seek and receive care. I have seen disinformation and misinformation spread faster than doctors and medical institutions can stamp out, from computer to phone to unwitting patient. With patients and their families presenting to pregnancy more often with neglected health, chronic illness, and basic misunderstandings and distrust of the “healthcare” system — some deserved — it should come as no surprise that pregnancy complications are on the rise.
Victims themselves, clinicians succumb to the same calamities afflicting their patients, from falling income and rising debt to over-emphasis on work over self-health. I myself was burning out. Feeling less and less meaning in treating ever more frequent and repetitive problems among my patients, I was admittedly fatigued from decades of the same without fundamentally bending the overall arc towards improvement. Just as with the unacceptable worsening of outcomes for pregnant persons, so too does society face unacceptable shortages, mental illness, and burn out for the healers of society.
Born from this angst, Lōvu restores equilibrium to clinicians and to patients. With our Continuously Connected Wellness™ model we shatter an archaic 90-year old rigid care paradigm that limits care providers and pregnant persons in lieu of a personalized approach that restores freedom and health to individuals. Via an AI-empowered human navigation and technology platform we monitor and assess women from pre-conception through 2 years postpartum, filling the gap between doctor visits, yielding novel insights into maternal health that previously were impossible to obtain. We connect patients with real human beings who match their culture and community, and who walk a similar life path. In so doing we restore human connection and create bonds that extend beyond cold, dispassionate medical care into warm, compassionate, insightful health education, coaching, and guidance. Through gentle nudges that reinforce the doctor’s care plan more effective change is possible. The result: strengthening healthful behaviors while reducing the need for in-office visits and medical interventions. Through Continuously Connected Wellness ™ Lōvu detects illness earlier than previously possible, giving doctors and midwives the chance to intervene before more serious harm occurs. But we don’t stop there: we recognize that we are not alone in our desire to restore health and to slice through access barriers for essential services so as physical, social, and emotional needs arise we connect patients and their families to best-in-class technologies and service platforms in our first-in-kind mom’s marketplace. The end result is an improved mother, baby, and family who can remain healthy for the longterm — a perfect ratio of health with medicine.
This is just a start, for it’s time to heal not just individuals, but to heal societies as well, as the health of an individual cannot exist in the absence of health of her greater society. As the remarkable Krishnamurti wrote in Commentaries on Living:
“Is society healthy, that an individual should return to it? Has not society itself helped to make the individual unhealthy? Of course, the unhealthy must be made healthy, that goes without saying; but why should the individual adjust himself to an unhealthy society? If he is healthy, he will not be a part of it. Without first questioning the health of society, what is the good of helping misfits to conform to society?”
Collectively we ignore dynamism in favor of rigidity and overly controlled circumstances. We ignore real world evidence at our own peril, force-fitting overly controlled and contrived studies for all patients from all walks of life, calamitously ignoring women, their pregnancy journeys, and their overall life journeys. We can fool ourselves into thinking we are ok, when in fact we may be ignoring blaring warning signs all around us. But so many of us are blind to these signals, suffering a lack of information and practical guidance, left struggling to amalgamate insights for ourselves but never truly knowing if they are valid. Nothing less than the health, prosperity, and longevity of our species is at risk. And so it’s time to start healing the ruptures in society, ruptures resulting from misapplication and unintended consequences of technology, from having left large swathes of people behind in the interest of making a fast buck, from chasing wealth for wealth’s sake.
At Lōvu we recognize that life is dynamic, not static, that meaningful life is resilient life, that healthy lives lead to healthy societies. We are not just a business to exact a return, but rather to effect a transformation in the wellbeing of one patient at a time, one family at a time, collectively yielding a better humanity for all. As we look to a New Year we unequivocally recognize that it’s time to set aside a Chief Medical Officer in favor of a Chief Health Officer.
Santosh Pandipati, M.D.
Co-Founder & Chief Health Officer, Lōvu Health
December 31, 2023
